Background Patients with respiratory disorders, including respiratory distress syndrome (RDS), require mechanical ventilation (MV) to maintain the pulmonary function. MV, however, is an invasive procedure that requires the administration of sedatives to simplify the procedure. Fentanyl and morphine are widely used opioids as sedatives in the intensive care unit (ICU). While there is less potential of morphine to cause tolerance, fentanyl has a faster onset and shorter duration of action.
Purpose To summarise the characteristics and gaps in methods and quality of reports of the comparative clinical and economic evaluations on the use of fentanyl and morphine in patients with respiratory disorders undergoing MV in the ICU settings.
Material and methods The electronic databases Medline, Embase, OVID, Science Direct, Springer Link and EconLit were used to identify comparative studies of either fentanyl or morphine or both, in the management of ventilated patients with respiratory disorders in the ICU. The outcome measures were the trends of methodological characteristics and designs of included studies. Appraisal of studies was performed via the Consolidated Standards of Reporting Trials, Strengthening the Reporting of Observational Studies in Epidemiology and Consolidated Health Economic Evaluation Reporting Standards checklists.
Results Among 1327 found articles, 33 met the inclusion criteria. Twenty-two studies were conducted in adults, eight in neonates and three in paediatrics. No head-to-head morphine versus fentanyl evaluation was explicitly undertaken only in participants with respiratory conditions. Studies relied on various types of scales to measure the sedation level as a primary study outcome, which limits the comparability of conclusions. Economic outcomes were evaluated in seven studies, only in adults and all from the hospital perspective. The same sedation regimen performed differently in various studies based on different endpoints. All of the randomised controlled trials, observational cohort and pharmacoeconomics studies did not meet the majority of assessed reporting quality criteria.
Conclusion Although the use of sedative regimens to manage mechanically ventilated patients with respiratory disorders is very high, the heterogeneity of studies disables the comparison of findings and, consequently, the construction of clear conclusions regarding the most effective and cost-effective sedatives. Evidence generated from poor reported studies may result in uninformed decisions by decision makers.
References and/or acknowledgements None.
No conflict of interest.